Provider Demographics
NPI:1841471125
Name:TINKER-PACHECO, VIRIS MAY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:VIRIS
Middle Name:MAY
Last Name:TINKER-PACHECO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OLD PALISADE RD
Mailing Address - Street 2:#17B
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7056
Mailing Address - Country:US
Mailing Address - Phone:201-947-3455
Mailing Address - Fax:201-947-3455
Practice Address - Street 1:2551 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6282
Practice Address - Country:US
Practice Address - Phone:212-222-5824
Practice Address - Fax:212-222-7582
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01562578Medicaid